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Voluntary Cough and Clinical Swallow Function in Children with Spastic Cerebral Palsy and Healthy Controls

  • Avinash Mishra
  • Georgia A. Malandraki
  • Justine J. Sheppard
  • Andrew M. Gordon
  • Erika S. Levy
  • Michelle S. TrocheEmail author
Original Article


Dysphagia and resulting pulmonary sequelae are frequently observed in children with spastic cerebral palsy (SCP). However, physiological evidence regarding airway protective behaviors (specifically swallowing and cough function) in these children is sparse. The aim of this investigation was to quantify specific feeding, swallowing, and cough impairments in children with SCP compared to controls. Eleven children with SCP (mean age: 7 ± 2 years; GMFCS: I–V; MACS: I–V) and 10 age-matched controls participated. Clinical feeding and swallowing performance was evaluated with the dysphagia disorder survey (DDS) using standardized liquid, puree, and chewable solid consistencies. Suprahyoid muscle activity and respiratory–swallow patterns were assessed with simultaneous surface electromyography and respiratory inductance plethysmography as children swallowed the various consistencies. Voluntary cough airflow measures were also obtained. Nonparametric tests were used for group comparisons and correlational analyses. Compared to controls, children with SCP demonstrated more signs of clinical feeding and swallowing impairment (p < 0.0001, η2 = 0.771), heightened suprahyoid muscle activity for puree (p = 0.014, η2 = 0.305) and chewable solids (p = 0.001, η2 = 0.528), more frequent post-swallow inhalation across liquid (p = 0.005, η2 = 0.401), puree (p = 0.014, η2 = 0.304), and chewable solids (p = 0.035, η2 = 0.223), and lower cough volume acceleration (p = 0.019, η2 = 0.289). Post-swallow inhalation for chewable solids was correlated with the DDS Part 1 (rs = 0.734, p = 0.010), DDS Part 2 (rs = 0.610, p = 0.046) and the DDS Total scores (rs = 0.673, p = 0.023). This study is the first to provide evidence of specific physiological deficits of both swallowing and voluntary cough in children with SCP. Potential hypotheses explaining these deficits and implications for physiologically driven management are explored.


Cerebral palsy Dysphagia Dystussia Pediatrics Deglutition Deglutition disorders 



The authors express sincere gratitude to the children and caregivers from the Center for Cerebral Palsy Research staff at the Teachers College, Columbia University for contributing their time toward the advancement of this clinical research. The authors acknowledge the valuable contributions of the research team and resources from the Laboratory for the Study of Upper Airway Dysfunction at the Teachers College.

Compliance with Ethical Standards

Conflict of interest

The authors declare no conflicts of interest.

Research Involving Human Participants

This research involved human participation at the Laboratory for the Study of Upper Airway Dysfunction at the Teachers College, Columbia University and was approved by the Institutional Review Board of the Teachers College, Columbia University. All participants volunteered for this research investigation.

Informed Consent

In addition to verbal consent, all caregivers and children (as dictated by IRB guidelines) signed informed consent forms following a thorough explanation of the clinical research protocol.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Avinash Mishra
    • 1
  • Georgia A. Malandraki
    • 2
  • Justine J. Sheppard
    • 3
  • Andrew M. Gordon
    • 3
  • Erika S. Levy
    • 3
  • Michelle S. Troche
    • 3
    Email author
  1. 1.Department of Speech, Language, and Hearing SciencesUniversity of ConnecticutStorrsUSA
  2. 2.Department of Speech, Language, and Hearing SciencesPurdue UniversityWest LafayetteUSA
  3. 3.Department of Biobehavioral Sciences, Teachers CollegeColumbia UniversityNew YorkUSA

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